SURGERY SCHEDULING PACKET

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1 SURGERY SCHEDULING PACKET Your Physician has recommended surgery for the treatment of your Orthopaedic condition. This means that your Physician feels your condition would improve with surgical treatment. You may or may not elect to proceed with surgery as recommended by your Physician. This packet was developed to help answer some of your questions regarding your surgery. We hope that we can make your surgical experience as pleasant as possible. Becky is the Surgery Scheduler for Dr. Stephen Pearce, Dr. John Pearce, Dr. Eugene Schoch, Dr Joshua Fox, Dr. Mark Parrella, and Dr. Galen Wachtman. Africa is the surgery scheduler for Dr.Charles Jason Hubbard, D.P.M. They will contact your insurance company to verify your surgical benefits and obtain any authorizations if needed for your surgery. They will contact the Surgery Facility and coordinate the next available time and date according to the physician s schedule and contact you.they will also inform you of any out of pocket cost for your physician s services. We ask you to please be patient and also to keep in mind that the surgery scheduling process may take somewhere from 5-10 business days, unless your Physician has marked your surgery as urgent; otherwise your surgery is considered as an elective procedure. Please have your calendar available when they call to give you the best service possible. If you have not heard from them in the time stated above please contact our office. Becky s direct line is and Africa s direct line is **Physician Fees are due 3 days before the surgery or the surgery will be cancelled. **Please note that the Facility Fees and the Anesthesiologist Fees are separate from the Physicians Fee.

2 Scheduling Your Surgery & Pre-Payment Policies *** Due to Insurances purposes and Facility Policies you must be seen by the physician within 30 days of a scheduled surgery. Surgery will be cancelled if you are not seen by the surgeon. *** Insurance Benefits As you know, most insurance plans require that you pay a deductible, co-pay or a co-insurance. We require that you pay your deductible, co-pay, co-insurance or any other out-of-pocket requirements for your surgery at least 3 days in advance. This pre-payment is based on an estimate, and the final bill may be less or more once the claim is processed by your insurance plan. For your convenience, payments can be made with cash, check, credit card or you can apply for care credit online at for a payment plan. Surgical Assistant Fee A licensed surgical assistant may be required based on the surgical procedure. Your physician will request the assistant only when necessary.this service maybe contracted from an outside company and your insurance may or may not cover the assistant charges. These charges will be your responsibility if they are not covered by your insurance company. Home Health Care Following some surgeries you may require home healthcare. For your convenience we will contact the physician s preferred company and provide them the necessary information to contact you and prepare you for going home after surgery. If you have another company you prefer, please let your physician or medical assistant know so we can get them the necessary information. Facility & Anesthesiologist Fee Our physicians have privileges at several different hospitals and surgery centers. The facility where your surgery is scheduled will contact you regarding their separate fees. Anesthesia is provided by the individual facility and they will be able to provide you with information regarding these fees. **SURGERIES MUST BE CANCELLED AT LEAST 3 DAYS PRIOR TO THE SCHEDULED DATE TO AVOID A $ LATE CANCELLATION FEE.** By signing below I am acknowledging I have read and understand the statements above. X Patient Signature Date X Print name

3 Pre-Op Clearance Information Occasionally, it is necessary to obtain a medical clearance from your Cardiologist, Internal Medicine Doctor, or Primary Care Physician prior to scheduling your surgery to make sure there are no underlying health issues that would prevent or delay you from having you procedure. Our office will request the clearance for your surgery but please keep in mind the clearing physician may need to see you in their office prior to providing this, and it will be your responsibility to schedule this appointment. Please provide us with the names of your physicians and their numbers if you have them below. Primary Care: Cardiologist: Internal Medicine: Thank you for your cooperation in this matter, Surgery Scheduling Department

4 Important Information Prior To Surgery **Do NOT eat or drink anything (water, gum, mints, coffee, juice, etc.) after midnight the night before your surgery unless otherwise notified. Please remember it is hazardous to undergo anesthesia or surgery with anything in your stomach. ** If you routinely take medications for other health conditions such as High blood pressure, you may take your medications on the morning of your surgery with a small sip of water only. ** Do NOT take any Aspirin and other anti-inflammatory drugs such as Motrin, Ibuprofen and Aleve, as these can cause excessive bleeding. **If you are on anticoagulants/blood thinner such as Coumadin (Warfarin) and Plavix (Clopidogrel) you must inform the performing surgeon. You can take Tylenol (acetaminophen) for pain relief. Medical History Prior to surgery, it is very important that your surgeon be up to date on your medical history and that any recent changes in your health or new diagnosis be reported. This may include, but not limited to diabetes, heart disease, lung problems, bleeding disorders or recent infections. Wear loose fitting clothing over the part of the body that you are going to have surgery. Tight fitting clothing may not be comfortable or fit over bandages, casts or splints. Please leave all your valuables and jewelry at home; there is not a safe place to lock up such belongings at the surgery center or hospital. If you are scheduled to stay overnight in the hospital, please remember to pack a small overnight bag accordingly.

5 ** If you are scheduled for outpatient surgery, you are not going to be capable to drive yourself home. Please make arrangements for your transportation home. ** You should arrive 1 (one) to 2 (two) hours prior to your surgery depending on the location of your surgery. If any Durable Medical Equipment (ex: crutches, slings, icepacks, etc.) is required a representative from our office will contact you to see what you have or may need. The Anesthesiologist, will either contact you the evening prior to your surgery or talk to you the morning of surgery to discuss any questions or concerns you may have. If you have any medical questions regarding your surgery we ask that you call our main number at or for Dr. Schoch and ask to speak with your physicians medical assistant.

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